Finding of microorganisms in patients with cervicovaginal polyps

Introduction: the variation of microorganisms of the vaginal canal is reported in patients with the presence of modified cervicovaginal polyps from the city of Puebla, Mexico; describing the vaginal microbiota and pathogenic microorganisms in order to analyze the possible association of these with the formation of cervicovaginal polyps. Methods: the clinical impressions and samples obtained from the patients who attended the Department of Cell Biology of the Faculty of Medicine of the Benemérita Universidad Autónoma de Puebla were analyzed within the framework of the Early Cancer Detection (DOC) program of the years 2001 to 2019, to the taking of cervicovaginal exfoliative cytology (PAP). Results: Of the 2,671 patients who met the inclusion criteria when presenting with cervicovaginal polyp, 82.14% reported the presence of microorganisms, being cocoid flora, the most frequent microorganism found in patients with cervicovaginal polyps, thus, the need for more studies deep and extensive in Mexico, due to the null reviews reported in the scientific literature.


Introduction
Deaths caused by diseases of the female genital tract increasingly affect the health of the entire world. Due to this, the need arises to perform annual reviews in patients with active sexual life for the early detection of any abnormality, thus, cervicovaginal polyps one of the most common lesions found in women of reproductive age with a fairly uncertain epidemiology and pathogenesis. 1,2 The human body harbor microbial ecological communities that are in a mutualist relation with the host and they inhabit surfaces and cavities in each sites of the body. 3 One that stands out is the vaginal ecosystem, made up of a microbiota that protects against pathogenic microorganisms involved in reproductive health and disease. While many factors, including ethnicity, diet, and cultural background, affect the vaginal microbiota predominantly due to the diversity of Lactobacillus species. [4][5][6][7] In this way, the vaginal environment is kept in balance due to the predominant action of Lactobacillus that maintain the acid pH in the vagina, and by generating an imbalance in the microenvironment, the protective effect on the integrity of the epithelial barrier decreases, causing vaginal infections of internal and external origin caused by bacterial, fungal, protozoan microorganisms and viruses, such as: Gardnerella vaginalis, Leptothrix actinomyces, Candida albicans and human papillomavirus (HPV). [7][8][9] It should be noted that Lactobacillus are key protective species of the vaginal mucosa that include 70% of the total population of the vaginal microenvironment in healthy women, express specific adhesion to surface epithelial cells, and also produce antimicrobial substances such as organic acids, peroxide hydrogen, bacteriocins and surfactants, thus hindering the establishment of pathogenic microorganisms. [8][9][10] With the advent of classification by molecular methods (fundamentally the analysis of the amplicon sequence of the 16S rRNA gene), it has been observed that there are approximately 45 species of Lactobacillus predominant in the vagina, with the greatest proportion being: Lactobacillus acidophilus, L.crispatus, L.iners, L.jensenii, L. gasseri, L. salivarius and L.vaginalis, all of them important for the maintenance of one of the most important microbiological communities of the body such as the vaginal microbiota. 3,11 This investigation is detailed as follows: Section 1: Introduction on the subject of vaginal microbiota and cervicovaginal polyps. Section 2: Description of the materials and methods used to obtain samples. Section 3: Analysis of results and partial conclusions and discussion of the topic.

Results and discussion
After reviewing the samples of the patients who manifested cervicovaginal polyps, the presence of various microorganisms was found, which are presented in Table 1. ) did not report any microorganism to the cytodiagnosis; these data are presented in Figure 1. In addition, of the 23 patients who presented some microorganism, we appreciate that 9 showed mixed flora (39.13%), that is, that they do not harbor a single microorganism but there is the presence of more than one of these, while in 14 patients was found cocoid flora as the only microorganism in our patients (60.86%), data presented in Figure 2.

Discussion
According to the bibliographies consulted, we know much of the etiology of the microorganisms already mentioned and the various clinical entities that cause them; such is the case of Gardnerella vaginalis, which depletes the Lactobacillus population and encourages the proliferation of anaerobic microorganisms, aminated odor, and increased vaginal discharge and pH (Photographs 2 and 3); Candida albicans, which due to the adherence of proteolytic enzymes causes erythema, pruritus, dysuria and vaginal discharge with a lumpy consistency (Photo 5); HPV, which causes low-grade intraepithelial injury and koilocyte formation thanks to the expression of proteins that penetrate the cervical basal layer (Photo 6) and Actinomyces species, for which there are few studies that provide information on their prevalence (Photo 4). 4 Based on the foregoing, the theory is reached that said microorganisms could affect the place of proliferation of a polyp by some mechanism not yet known, thus highlighting the presence of important clinical manifestations found during the performance of cervicovaginal exfoliative cytology. , such as: erosion, leucorrhea, vulvar itching, bleeding at intercourse and dyspareunia, as well as results reported in the interrogations and gynecological impressions of the patients, highlighting changes in the pH and alteration of the integrity of the vaginal epithelium; thus, the microorganisms of the vaginal canal are involved in the formation of cervicovaginal polyps, with histological and cellular modifications, as well as chronic infections, being responsible for said appearance.
However, we must prioritize the clinical manifestations and the establishment of microorganisms are attributed to specific cervicovaginal infections and normal vaginal microbiota. 4,[7][8][9] Thus, these microorganisms are not related to the formation of polyps, since the finding of these in the samples analyzed is a sporadic discovery and the formation of cervicovaginal polyps is attributed to other well-known independent causes and mechanisms, such as : proliferative processes, vascular neoformations, hormonal factors (hyperestrogenic), genetic modifications, chronic inflammatory phenomena, stromal hyper cellularity, cytological atypia, increased mitosis, hyperplasia of the glandular and endometrial epithelium; as well as aging, insulin resistance, obesity, high blood pressure, postmenopausal period, smoking and tamoxifen use. [15][16][17] .

Conclusion
After analyzing the results and studying the colonization mechanisms of the microorganisms found in our patients, the presence of these is concluded, they are a fortuitous finding due to the null cases reported in the literature; The routes by which these microorganisms are defined in the vaginal canal are currently known, so the scope of this search shows that there is no direct association with the formation of cervicovaginal polyps, which is why it is indicated in the development of this investigation.